One of the big claims from Government, which has been associated with the three years of additional funding for the PCEHR, is that they are going to re-develop the PCEHR to make it more usable for clinicians as this issue was raised by the Royle Review as a major problem.
It seems to me that this is a very, very hollow claim. Thinking about it lets see what can’t be fixed.
1. The PCEHR can never have the flexibility of a locally based Clinical System in displaying the various information held. Simply clicking the various tabs can display much more information than will ever be held (or should be) in the PCEHR.
2. The PCEHR will never be a primary system for the GP and will only be consulted for the occasional patient (who is new to the practice or is away from home) whereas the GP System will be used all the time but it will need to be consuming practitioner time (and costing money) while waiting for the PCEHR to be updated.
3. The speed of access to the PCEHR via the internet will never match the speed and convenience of a local system and most of the time will be irrelevant for the care of most patients.
4. The PCEHR interface will inevitably be less familiar and different to the familiar GP system and so may be less speedy to interpret and understand.
5. Access to the PCEHR during the consultation will always require a conscious decision and extra key clicks and time.
6. Consent for information upload of a clinical summary will need to be obtained on every occasion - with the time involved - in the opt-out environment as consent cannot be assumed before each consultation.
7. Without a major re-design the information held in the PCEHR will not be discreet information but rather lumpy .pdfs which will not provide the utility of results obtained direct from laboratories in terms of cumulative reporting and trend observation.
8. The local system will inevitably contain information which has been locally developed and derived and so will be intrinsically more useful to and trusted by the practitioners in that practice.
9. Inevitably access to the PCEHR will impose workflow and speed consequences and even if a record is known to exist there will be quite a high threshold to spend the time to look up the PCEHR in most cases - unless such access is made mandatory - in which case a clinical revolt, in the absence of major financial incentives, - would be inevitable.
In essence there is no amount of application of lip-stick to this pig that will give it the ease of use, speed, comprehensiveness, familiarity and relevant detail provided by local systems.
I am sure this is what most GPs would see as usability and it seems to me the PCEHR is never going to be in the ball park of what might be required for GP satisfaction.
Delivering the speed, richness and familiarity that is required for real acceptance is just not possible IMVHO.
Do you think the DoH can deliver a usable fix or do you have other issues to add? Let us all know.